Concentric electrodes for producing acupuncture-like anesthetic effects

We designed concentric electrodes composed of a center electrode and an outer ring electrode. Electrical stimulation with two sets of such electrodes for 15 min as conditioning stimuli was given to the left hand of 35 adult subjects to induce acupuncture-like anesthetic effects. The effects immediately after the conditioning were compared between stimulation through a pair of center electrodes alone at 3 Hz (conditioning 1) and simultaneous stimulation of 3 Hz through a pair of center electrodes and 100 Hz through a pair of outer ring electrodes (conditioning 2). In conditioning 2, modulating effects of 100 Hz stimuli through a pair of outer ring electrodes made it possible to increase the voltage strength of 3 Hz stimuli through a pair of center electrodes with maintaining the minimum perception of pricking sensation. In both conditioning procedures, muscle twitching was not accompanied. It was found that the respective stimulating current thresholds for faint touch sensation and also for pricking sensation at the right forearm could be elevated significantly more by conditioning 2 (1.54 and 1.40 times) than by conditioning 1 (1.20 and 1.14 times).

Utilization of transcutaneous electrical nerve stimulation in managing craniofacial pain

This article describes a protocol for clinical application of variable parameter transcutaneous electrical nerve stimulation (TENS) for the management of craniofacial pain. The method described is easily applied and has been used successfully for several years in clinical practice. Several selected cases are presented that demonstrate the use of TENS along the prescribed protocol.

Technique of pudendal nerve localization for block or stimulation

A diagnostic technique is described for study of the pudendal nerve via a dorsal rather than perineal approach. The method offers unique advantages for the urodynamic study of sphincteric function. The patient is placed in the prone position with slight flexion of the hips. The position of the ischial spine is identified topographically using the ischial tuberosities, greater trochanter and lower edge of the ischial-tuberous ligament. Local anesthesia and electrical stimulation then are used to position a needle tip adjacent to the pudendal nerve. This approach allows for specific localization of the nerve for accurate temporary or permanent nerve block. It also permits continuous urodynamic monitoring of pelvic floor behavior with stimulation of the pudendal nerve to assess functional integrity of the nerve and the pelvic floor striated muscles.

[The effectiveness of electromyostimulation following operations of the capsule-ligament system of the knee joint in athletes]

The most important factor in rehabilitation after knee joint surgery is the influencing of the atrophy of the femoral musculature and the recovery of the arthromuscular balance. Electromyostimulation (EMS) should be an additional possibility of treatment. Longitudinal section studies were performed over 6 months in a group of 45 patients after cruciate ligament surgery and for a period of 3 months after meniscus surgery in a group of 61 patients, in each case with different aftertreatment programmes (with EMS vs without EMS). Muscle function control methods were used to assess the condition of the status of function of the musculature (M. vastus medialis). The effect achieved by EMS can be objectivated especially by means of the muscular tone parameters "elastic retraction" and "total compressibility". In the group of sportsmen with EMS treatment (low frequency constant frequency programme with mini-stimulant twice daily 15 minutes) these parameters are about 30% above those of the group without EMS. Timely and on-target use of EMS after knee joint surgery yields a better starting level for rehabilitation and is in our opinion mandatory as a matter of principle especially in high-performance sportsmen.

The combined effect of nitrous oxide and oxygen and electrical stimulation during restorative dental treatment

A total of 124 adult patients were treated with nitrous oxide (N2O) and oxygen (O2), an electrical analgesic, or a combination of N2O/O2 and an electrical analgesic during restorative dental procedures. The use of electrical analgesic or N2O/O2 without local anesthetics resulted in a high failure rate and poor patient acceptance. However, combining N2O/O2 sedation with electrically induced analgesia resulted in a statistically significant improvement over either technique used alone, and provided an overall 81% success rate when used during restorative dentistry.

[Anesthesia by transcutaneous electroneurostimulation in preparing teeth for artificial crowns]

High efficiency of percutaneous electroneurostimulation induced by a portable device "Elektronika EPB-50-01" was evidenced in preparation of teeth for different types of artificial crowns. The method of reflex anesthesia induces no complications, is completely safe and simple in use.

Spinal cord stimulation (SCS) in the treatment of postherpetic pain

SCS is considered to be of poor value in treating postherpetic pain. We have retrospectively analyzed the results obtained in 10 patients suffering from postherpetic neuralgia. An epidural electrode was implanted, aiming the tip in a position where stimulation could produce paraesthesiae over the painful area. At the end of the test period 6 out of 10 patients reporting a mean analgesia of 52.5% underwent a permanent implant. At mean follow-up (15 months) all the 6 patients were still reporting a satisfactory pain relief (74% of mean analgesia). These figures remained unchanged at the next follow-ups (max 46 months). The result of SCS in our patients, although positive in only 60% of them, are remarkably stable with time. We therefore recommend a percutaneous test trial of SCS in every case of postherpetic neuralgia resistent to medical treatment.

Clinical evaluation of FasTENS, an inexpensive, disposable transcutaneous electrical nerve stimulator designed specifically for postoperative electroanalgesia

Previous studies have shown that electroanalgesia is an effective method of reducing postoperative pain in patients who have urologic surgery. All prior studies of postperative transcutaneous electrical nerve stimulation (TENS) have employed TENS stimulators which were designed for the control of chronic pain. Disadvantages to the use of standard TENS stimulators in postoperative patients include the high cost of the devices and their operative complexity which make it difficult for staff and patients to use them. FasTENS is a lightweight, relatively inexpensive disposable TENS stimulator which has been designed specifically for use in postoperative patients. We evaluated the effectiveness of FasTENS in patients who had implantation of an inflatable penile prosthesis, radical retropubic prostatectomy, or radical nephrectomy. Patients treated with FasTENS used 60 percent less pain medication (P less than 0.001) and made 61 percent fewer requests for Demerol injections (P less than 0.001) than did control patients who were not treated with postoperative electroanalgesia. FasTENS was most effective in patients who had radical prostatectomy or penile prosthetic surgery. FasTENS was not cost-effective or practical in patients who had radical nephrectomy.

[Punctate transcutaneous electrical nerve stimulation in migraine therapy]

Pharmacotherapy of migraine is not satisfying at present, especially in case of frequent attacks of headache. Therefore alternative methods of treatment gain increasing relevance. Based upon many years of experience with specific reflexotherapy and conventional stimulation therapy for treatment of pain we started a clinical study in migraine applying the punctual transcutaneous electrical nerve stimulation (PuTENS) performed with self-made pocket electrostimulators (TRG I-III). The study includes self-treatment of patients at home. After more than 6 months PuTENS was prophylactically effective in 225 out of 282 patients, i.e. in 80% of cases the frequency of attacks and the use of drugs were reduced to at least 50%. In 90 patients treated by the physician the rate of improvement was 86% compared to 76% in 192 patients, which performed self-treatment according to the physician's instruction and under medical supervision. 96 out of 160 patients with migraine could alleviate their acute headache by PuTENS applying the pocket electrostimulator at home. In conclusion, PuTENS is superior to drug therapy and conventioned electrotherapy in the treatment of migraine. Its effectiveness is similar to needle acupuncture. The method can therefore be regarded as a valuable alternative and help for patients with frequent headache.

[Punctate transcutaneous electrical nerve stimulation in functional vertebragenic disorders and in migraine]

Chronic and frequently relapsing headaches as well as myalgic-vertebragenic pain syndromes belong to the most frequent pain diseases. Among the non-medicamentous methods the techniques of the aimed reflex and stimulation therapy such as acupuncture, neural therapy and manual medicine particularly stood the test. As a non-invasive alternative we try to replace the needle acupuncture by punctuate transcutaneous electric nerve stimulation. With the help of self-constructed pocket stimulating current devices we treated 740 patients suffering from pain (420 with myo-vertebragenic and 320 with primary headaches) and achieved 90% of immediate successes and 70-80% improvement after 6 months. The treatments could be objectifie thermometrically. Own prospective randomized studies of placebo-treatment and medicamentously controlled studies of treatment and changes of the pain threshold by means of the PuTENS were briefly represented and the mechanism of action was discussed. The application of this effective, free of side effects, undangerous, economic method easily to be learned which is suitable for the autotherapy and sanatory therapy is recommended for the alleviation of pain.

Selected problems in the use of transcutaneous electrical nerve stimulation for pain control--an appraisal with proposed solutions. A special communication

The purposes of this communication are 1) to call attention to several problematic issues related to the use of transcutaneous electrical nerve stimulation for pain control and 2) to consider strategies for correcting existing problems and averting additional problems in the future. Specific problems within two general areas of difficulty are identified, and proposed solutions to these problems are presented. It is hoped that discussion of these issues will encourage comment and debate, bring about further objective and critical evaluation of the effectiveness and value of TENS for pain control, and lead to a clearer understanding of the responsibilities of manufacturers and users of this therapeutic modality.

Transcutaneous electrical stimulation and the sensation of prickle

1. A high-voltage low-current transcutaneous electrical stimulating device was constructed and tested for its suitability to evaluate fabric-evoked prickle sensitivity in a population of 162 subjects. The initial sensation experienced by subjects with this device was the unpleasant sensation of prickle. 2. Single-unit recordings from the rabbit saphenous nerve established that at threshold most unmyelinated cutaneous receptors, both C low-threshold mechanoreceptive and polymodal nociceptive, were activated by the device. 3. Threshold measurements showed that there was no relationship of electrical threshold to atopic status, nor to fabric prickle threshold. It was concluded that our device preferentially excites unmyelinated afferents, but is not useful as a screening device for fabric intolerance.

The use of electronarcosis as anaesthetic in the cichlid, Oreochromis mossambicus (Peters). I. General experimental procedures and the role of fish length on the narcotizing effects of electric currents

Procedures to narcotize fish by means of alternating or direct electrical currents are described and a method of evaluating the narcotic effects on fish of electrical currents is detailed. The role of fish length on the narcotizing potential of electrical currents was investigated. The results indicate that there is a positive correlation between fish length and the duration of narcosis.

Transcutaneous muscle stimulation promotes muscle growth in immobilized patients

Muscular activity is a fundamental determinant of muscle mass. Transcutaneous muscle stimulation (TMS) may reverse muscle atrophy and lean mass loss in immobile patients by "artificial exercise." Four paraplegic patients with upper motor neuron lesions entered The Ohio State University Clinical Research Center for a 21-day metabolic balance study. After 6 days of baseline monitoring, each underwent isometric tetanic contractions (15 sec on; 45 sec off) of all major lower extremity muscle groups with TMS for 10 hr daily. Cross-sectional areas of muscle plus bone were calculated with CAT scan planimetry at 7 levels in both lower extremities before and after the TMS period. Three patients completed the metabolic balance study. TMS produced significant growth of innervated thigh and calf muscles in all paraplegic patients. Little growth occurred where bone and tendon predominate. No significant changes in nitrogen balance (urine and stool excretion), potassium balance (urine excretion only), or phosphate balance (urine excretion only) could be demonstrated. Two possible explanations are (1) that the patients may have been underfed and (2) that perhaps due to an increase in metabolic rate owing to the stimulation, lean tissue in other locations may have been mobilized to meet leg muscle demands. Future studies will incorporate metabolic monitoring of oxygen consumption and CO2 production during the experiment.

The electrospinal treatment of idiopathic scoliosis in the adolescent

The transcutaneous electrospinal treatment adds another approach to the conservative treatment of small and moderate idiopathic scoliotic curves. The method presented here is readily accepted by both the adolescent and the parents. It is inexpensive, and allows flexibility as to the location and number of electrodes to be used and the curve treated. The data presented here, collected over a five-year period of clinical monitoring and recording, indicate that results are favorable, therefore, the method is acceptable.

External electrical tinnitus suppression: a review

Our experience with transcutaneous electrical stimulation for tinnitus suppression has been with the Theraband Headset from Audimax Inc. The purpose of this article is to review the highlights of the patients who exhibited tinnitus suppression and/or tinnitus control, and to provide an update of our results and techniques using external electrical stimulation with prolonged stimulation (stage IV). Patient selection is considered critical to the success of external electrical stimulation for tinnitus suppression. The key elements include the clinical finding of a peripheral site of lesion of the tinnitus; positive maskability of the symptom of tinnitus; absence of active ear disease; absence of a vestibular asymmetry; and absence or minimal evidence of dysfunction of the central auditory system. The protocol described for patient selection allows for tinnitus identification, the differentiation of clinical tinnitus types, and the clinical application of the concept of the dynamic range of electrical tinnitus suppression. External electrical tinnitus suppression is believed effective in a limited number of patients clinically identified as having a tinnitus site of lesion primarily peripheral in location and cochlear in type. The present device is not commercially available at this time. Both specific and general suggestions are proposed for the standardization of methods of reporting results of electrical tinnitus suppression and tinnitus control.

[Sonographic detection of increased perfusion in placental insufficiency following TNS therapy using pulsed Doppler ultrasound]

In the last years transcutaneous electric nerve stimulation (TNS) has been used at the first Department of Gynaecology and Obstetrics in Vienna for the therapy of placental insufficiency. With the new method of Doppler Ultrasonography a direct measurement of blood flow in the Arteriae umbilicales is possible. In 16 patients with reduced placental perfusion between 34 to 38 weeks of pregnancy TNS-therapy has been monitored by Doppler Ultrasonography. In 14 patients an impressive improvement to normal values of perfusion could be observed. Only 2 patients with morphological changes in the placenta were resistant to therapy. A control group of 16 patients with normal values of perfusion did not show any response to TNS-therapy as expected. Therefore this safe and simple method of TNS is recommended for the therapy of functional placental insufficiency.

An evaluation of the clinical analgesia/anesthesia efficacy on acute pain using the high frequency neural modulator in various dental settings

The purpose of this study was to evaluate the effectiveness of high frequency neural modulation as a substitute for traditional local anesthesia in various dental procedures. This double-blinded study was done to evaluate patient comfort and degree of satisfaction as well as manageability of pain control by the operator during the dental procedures. Procedures included restorations, tooth extractions, root planing, pulp extirpation, and temporomandibular joint therapy. In the experimental group, favorable responses ranged from 0.0% to 92.8%, depending on the procedures. An overall favorable rating of 71.8% was given by the experimental group, and an overall favorable response of 8.5% was given by the placebo group.

Vertical dimension and freeway space. A kinesiographic study

A statistical correlation is found between the S-N/mandibular plane angle and clinical freeway space, but there was no correlation after TENS stimulation. The S-N/MP angle did not prove to be a reliable predictor of freeway space.

New screening device for assessment of peripheral neuropathy

Screening for the onset of toxic and entrapment neuropathy is a major concern in occupational medicine today. Current perception thresholds may be used as a measure of the integrity of the peripheral nervous system. A new transcutaneous nerve stimulator was used to evaluate current perception thresholds in 54 normal persons and 33 diabetic subjects. Current perception thresholds in the normal volunteers with no evidence of peripheral neuropathy were found to vary significantly with the frequency and location of the stimulation, as well as age. The test identified the diabetic peripheral neuropathy with an overall sensitivity of 94%. This new diagnostic technique is quick, simple to perform, noninvasive and nonaversive and provides a sensitive quantitative measure of sensory function. This diagnostic stimulator will be useful for screening occupationally related toxic and entrapment neuropathies in which sensory impairment is an early finding.

[The ELIMAN-401 analgesic transcutaneous electrostimulator with automatic adjustment of the length of the stimulus]

The authors describe the design of a new electrostimulator for intraoperative and postoperative anesthesia and relief of neurological and traumatological pain. The main technical characteristics and results of clinical tests are presented.

[The Delta-102 2-channel electrostimulator for pain relief]

Delta-102 two-channel electrostimulator for pain relief was created on the basis of tests and clinical application of analgetic percutaneous electrostimulation (APES). It extended the indications to APES application in surgery and increased the efficiency of treatment.

[Use of central electroanalgesia to restore the body's functional state in motion sickness]

Central electroanalgesia (CEAN) is a technique that involves application of pulsating current to the central nervous system in order to enhance its tonicity recover autonomic equilibrium and to reduce parasympathetic cardiovascular reactions. In two experimental runs in which 9 volunteers participated the efficacy of CEAN in preventing motion sickness symptoms produced by Markaryan's test was studied. After two rotations repeated with a one-hour interval vestibular reactions persisted for 7-10 hours. CEAN had a positive effect: after a one-hour CEAN session applied between two rotations the tolerance time of the second rotation increased on an average by 76%. An additional exposure to CEAN after rotation eliminated almost completely the adverse effects of rotation and made effective the postrotation work. Due to CEAN parasympathetic reactions of the cardiovascular system typical of the postrotation recovery period were indistinct. These data suggest that CEAN is an effective method to be used to help a rapid recovery of the functional state of the human body during motion sickness.

Treatment of trigger points with microamperage transcutaneous electrical nerve stimulation (TENS)--(the Electro-Acuscope 80)

One-half of the students taking part in a double-blind study received a microamperage electrical stimulation of trigger points in the neck and shoulder region with the Electro-Acuscope 80. All the subjects were evaluated by digital palpatory physical examination for the presence of trigger points before each of their treatments. Results indicate that the subjects who received treatment had a higher change of trigger-point indicators compared to those receiving the placebo treatment. A two-tailed t-test indicated significant results (P less than 0.001). It appears that microamperage electrical stimulation is effective in the treatment of trigger points.